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Our 2nd "Bug Challenge" comes again from Mahosot Hospital, Vientiane, Laos where Dr David Dance works as a Clinical Microbiologist.
He presented with a 5 day history of fever, headache, jaundice and neck stiffness. In the two days prior to admission he had been vomiting and had become increasingly deaf. He had previously been fit and well, although he drank alcohol excessively. Examination revealed a fever of 39°C and confirmed the deafness and neck stiffness but was otherwise unremarkable. Routine haematology and blood chemistry showed only a neutrophil leukocytosis and raised urea and bilirubin.
A lumbar puncture performed on the day of admission showed an opening pressure > 40 cmH2O, and yielded turbid CSF with a total cell count of 200 cells/ml (polymorphs 65%, lymphocytes 35%), protein 168 mg/dl, lactate 10 mg/dl and glucose 60 mg/dl (blood glucose 112 mg/dl). India ink and ZN stains were negative. The Gram stain of the CSF is here and here.
The patient recovered quickly on treatment with ceftriaxone 2g bd with dexamethasone 4 mg tds for the first 3 days.
1.What is this organism likely to be?
2.What are its main microbiological characteristics?
3.What other questions should be asked about the patient’s history?
This resource was originally posted in Global Health Microbiology